Individual
JEFFREY LAWRENCE BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1140 W LA VETA AVE, STE. 850, ORANGE, CA 92868-4225
(714) 560-4450
(714) 560-4455
Mailing address
PO BOX 6898, ORANGE, CA 92863-6898
(714) 571-5000
(714) 571-5055
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
G61836
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G618360
BLUE SHIELD OF CA
—
05
—
00G618360
—
CA
01
—
00G618360 M46
CALOPTIMA
—
01
—
050069CD43675
TRAILBLAZER
—
01
—
P00139413
RAILROAD MEDICARE
—
Enumeration date
08/02/2005
Last updated
08/18/2008
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